罗哌卡因联合右美托咪定在术终乳腺癌切口局部浸润镇痛中的应用效果

The application of rapivacaine combined with dexmedetomidine local infiltration analgesia in breast cancer incision at the end of operation

目的分析罗哌卡因联合右美托咪定在术终乳腺癌切口局部浸润镇痛中的临床应用效果。方法选取2014年3月至2019年3月于合肥市第二人民医院行择期乳腺癌手术的74例患者为研究对象。采用随机数字表法将入选患者分为观察组和对照组,每组各37例,缝皮结束时,给予对照组患者罗哌卡因切口局部浸润镇痛,给予观察组患者罗哌卡因联合右美托咪定切口局部浸润镇痛。使用视觉模拟评分法(visual analogue scale,VAS)、Ramsay评分和布鲁格曼舒适量表(Bruggrmann comfort scale,BCS)评估两组患者术后不同时间点镇痛、镇静和舒适状态,比较两组患者苏醒时间、拔管时间、排气时间、补充镇痛率、镇痛泵按压次数和不良反应发生率。结果观察组患者术后排气时间和离床活动时间均显著早于对照组(均P<0.05),术后24 h补充镇痛率显著低于对照组(P<0.05)。两组患者术后4 h、8 h VAS评分均显著高于本组术后2 h(均P<0.05),Ramsay评分和BCS评分均显著低于本组术后2 h(均P<0.05);术后24 h,两组患者VAS评分均显著低于本组术后2 h(均P<0.05),Ramsay评分均显著高于本组术后2 h(均P<0.05);观察组患者术后2 h、4 h、8 h、12 h、24 h VAS评分均显著低于同期对照组(均P<0.05),BCS评分均显著高于同期对照组(均P<0.05),术后2 h、4 h、8 h Ramsay评分均显著高于同期对照组(均P<0.05)。观察组患者术后8~12 h、12~24 h镇痛泵按压次数均显著少于对照组(均P<0.05)。两组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论罗哌卡因联合右美托咪定在术终行乳腺癌切口局部浸润镇痛,能够提高镇痛、镇静效果,改善患者术后舒适度。

Objective To analyze the clinical application of ropivacaine combined with dexmedetomidine local infiltration analgesia in breast cancer incision at the end of operation.Method From March 2014 to March 2019,74 patients who underwent selective breast cancer surgery in Second People's Hospital of Hefei were randomly divided into observation group and control group,with 37 cases in each group.At the end of the suture,control group patients were given ropivacaine for local infiltration analgesia,observation group patients were given ropivacaine combined with dexmedetomidine for local infiltration analgesia.The visual analogue scale(VAS)score,Ramsay score and Bruggrmann comfort scale(BCS)score were used to evaluate the postoperative analgesia,sedation and comfort state of the two groups.The recovery time,postoperative extubation time,postoperative exhaust time,usage rates of supplementary analgesics,pressing times of analgesic pumps and incidence of adverse reactions were compared between the two groups.Result The postoperative exhaust time and ambulation time of patients in observation group were significantly earlier than those in control group(all P<0.05),and the postoperative 24 h usage rates of supplementary analgesics was significantly lower than that in control group(P<0.05).The VAS scores at 4 h and 8 h after operation in both groups were significantly higher than those at 2 h after operation(all P<0.05),while Ramsay scores and BCS scores were significantly lower than those at 2 h after operation(all P<0.05).24 h after operation,the VAS scores of the two groups were significantly lower than 2 hours after operation(all P<0.05),and Ramsay scores were significantly higher than those at 2 h after operation(all P<0.05).The VAS scores of observation group were significantly lower than those in control group at 2 h,4 h,8 h,12 h and 24 h after operation(all P<0.05),the BCS scores were significantly higher than those in control group at the same period(all P<0.05),and the Ramsay scores at 2 h,4 h and 8 h after operation were significantly higher than those in control group at the same period(all P<0.05).At 8~12 h and 12~24 h after operation,the press times of analgesic pump in observation group were significantly less than those in control group(all P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Ropivacaine combined with dexmedetomidine for local infiltration analgesia of breast cancer incision at the end of operation can improve the effect of analgesia,sedation and postoperative comfort.